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1578085239 NPI number — THE CREED OF RECOVERY, LLC

NPI Number: 1578085239
Health Care Provider/Practitioner: THE CREED OF RECOVERY, LLC

Information about “1578085239” NPI (THE CREED OF RECOVERY, LLC) exists in 1578085239 in HTML format HTML  |  1578085239 in plain Text format TXT  |  1578085239 in PDF (Portable Document Format) PDF  |  1578085239 in an XML format XML  formats.

NPI Number : 1578085239 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1578085239",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "THE CREED OF RECOVERY, LLC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "PO BOX 243",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SUGAR GROVE",
    "MailingAddressStateName": "OH",
    "MailingAddressPostalCode": "43155-0243",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "614-404-6008",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "551 E MAIN ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "LANCASTER",
    "PracticeLocationAddressStateName": "OH",
    "PracticeLocationAddressPostalCode": "43130-3809",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "614-404-6008",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "07/13/2017",
    "LastUpdateDate": "07/13/2017",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "EVANS",
    "AuthorizedOfficialFirstName": "ANDRIA",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "CEO",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "CEO",
    "AuthorizedOfficialTelephoneNumber": "614-404-6008",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "251B00000X",
          "TaxonomyName": "Case Management Agency",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "261QR0405X",
          "TaxonomyName": "Substance Use Disorder Rehabilitation Clinic/Center",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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